addicted_pb 4/24/08 5:02 PM Page 1 $16.95 Freimuth PSYCHOLOGY • ADDICTION/TREATMENT RECOGNIZING DESTRUCTIVE “Addicted? is a guide for taking action against the deception of addiction, while there’s still time. A must-read for anyone facing the deception, denial, and desperation of addic- BEHAVIOR BEFORE tion.” —William Cope Moyers, author of Broken: My Story of Addiction and Redemption “Addicted? should be required reading for everyone who suspects that they or their IT’S TOO LATE loved one might be an addict. Addicts lead secret, double lives; now, at long last, this book strips off the mask of the addict, removes the layers of clinical and societal con- fusion, and speaks the truth about our deeply addicted culture.” —Sue William Silverman, author of Love Sick: One Woman’s Journey through Sexual Addiction “Addicted? de-stigmatizes addiction and offers hope for those who struggle, whether Addicted? adolescent, young adult, aging adult, or concerned friends and family. Addicted? is a book to read at first suspicion, when you may already be wondering how it could have happened.” —Chris Volkmann, coauthor of From Binge to Blackout: A Mother and Son Struggle with Teen Drinking Nationally recognized addiction expert Marilyn Freimuth provides a step-by-step guide for identi- fying addictions and beginning to seek help. With engaging case studies and sensitive analysis, Dr. Freimuth shares easy-to-use worksheets and tools to help readers identify and seek treatment for a range of addictions. She emphasizes that almost any behavior can become addictive and specifically addresses the common addictions: Addicted? SUBSTANCES • GAMBLING • SEX • INTERNET • SHOPPING • EXERCISE Marilyn Freimuth is a psychologist specializing in addiction diagnosis and treat- ment and a professor of clinical psychology at the Fielding Graduate University in Santa Barbara, California. She lives in Wisconsin, consults around the country, and “A wise approach to figuring out whether you or your loved one suffers with addiction. maintains a practice in New York. I very much recommend it.” —Lance Dodes, M.D., author of The Heart of Addiction ROWMAN & LITTLEFIELD PUBLISHERS, INC. LITTLEFIELD A wholly owned subsidiary of ROWMAN & The Rowman & Littlefield Publishing Group, Inc. 4501 Forbes Boulevard, Suite 200 Lanham, Maryland 20706 www.rowmanlittlefield.com ISBN-13: 978-0-7425-6025-3 Marilyn Freimuth, Ph.D. Distributed by ISBN-10: 0-7425-6025-2 NATIONAL BOOK NETWORK 51695 1-800-462-6420 9 780742 560253 Cover design by Jen Huppert Design Addicted? Addicted? RECOGNIZING DESTRUCTIVE BEHAVIOR BEFORE IT’S TOO LATE Marilyn Freimuth, Ph.D. ROWMAN & LITTLEFIELD PUBLISHERS, INC. Lanham • Boulder • New York • Toronto • Plymouth, UK ROWMAN & LITTLEFIELD PUBLISHERS, INC. Published in the United States of America by Rowman & Littlefield Publishers, Inc. A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc. 4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706 www.rowmanlittlefield.com Estover Road Plymouth PL6 7PY United Kingdom Distributed by National Book Network Copyright © 2008 by Rowman & Littlefield Publishers, Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photo- copying, recording, or otherwise, without the prior permission of the publisher. British Library Cataloguing in Publication Information Available Library of Congress Cataloging-in-Publication Data Freimuth, Marilyn, 1951– Addicted? : recognizing destructive behavior before it’s too late / Marilyn Freimuth. p. cm. Includes bibliographical references and index. ISBN-13: 978-0-7425-6025-3 (pbk. : alk. paper) ISBN-10: 0-7425-6025-2 (pbk. : alk. paper) eISBN-13: 978-0-7425-6589-0 eISBN-10: 0-7425-6589-0 1. Compulsive behavior—Popular works. 2. Substance abuse—Popular works. I. Title. RC533.F744 2008 616.85'84—dc22 2008006816 Printed in the United States of America ™ °° The paper used in this publication meets the minimum requirements of Ameri- can National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI/NISO Z39.48-1992. Contents PART I: GETTING TO KNOW ADDICTION 1 1 The Problem: Recognizing Addiction When It’s Too Late 7 2 The New Look of Addiction 18 3 The Making of an Addiction 34 4 The Continuum: Early to Late Stage Addiction 47 5 Addiction’s Many Masks 58 6 Addiction’s Self-Disguises 70 7 Subtle Signs of Addiction 78 PART II: UNMASKING ADDICTION 87 8 Unmasking Substance Addictions 93 9 Adolescent Substance Use: Experimentation or Addiction? 113 10 The Unseen Faces of Addiction: Older Adults and Women 130 11 Gambling Addiction 141 12 Computer Addiction 156 13 Sex and Cybersex Addictions 169 14 Buying Addiction 183 15 Exercise Addiction 194 V VI ■ CONTENTS PART III: GETTING HELP FOR AN ADDICTION 207 16 Unmasking Addiction and Preparing for Change 211 17 Impediments to Effective Helping 240 Appendix I: An Overview of Addiction-Induced Psychological 255 and Physical Changes Appendix II: Common Addictive Substances 261 References 265 Index 279 PART I Getting to Know Addiction very day you meet someone who has addiction. In fact, you most likely meet several people, each having a different kind of addiction. These Eare not strangers you have passed on the street. They are not the stereo- typical junkies passed out in doorways. These are people you know, perhaps even well: friends, clients, coworkers, maybe even someone you love. And just as you do not recognize them as being addicted, it is likely that they, too, do not know they have a problem. I know this because it happened to me. I’m a psychologist and trained psychotherapist, a Ph.D., with a thriving private practice. Despite being in practice for twelve years, I had never treated an addict among my many patients. Or so I thought. I was to find out that I was very wrong. It is my hope that the reader will make the same lifesaving dis- coveries that I have made. This is knowledge you need to have because the 1 2 ■ ADDICTED? people charged by society to identify addictions—health care providers such as physicians, psychiatrists, nurses, social workers, and clinical psychologists— continue to do an inadequate job of diagnosing addictions. Addiction Is the Number-One Public Health Problem Most people believe that cancer, heart disease, and obesity are the major health concerns in this country. Yet in terms of direct and indirect costs, addictions are the number-one public health problem (To, 2006). People with addictions make more medical visits than those without addictions. Substance-related disorders are the most frequently occurring mental health problem (Brems and Johnson, 1997). Problematic substance use is impli- cated in close to one quarter of the annual deaths in the United States. Esti- mates suggest that one dollar of every twelve spent for health care is related to an addiction (Institute of Medicine, 1997). Clearly, the impact of addictions spreads far beyond costs to the health care system. Addiction is often referred to as a family disease. Like a virus, the subtle and not-so-subtle effects of living with an addicted family mem- ber spread to every member of the family. The emotional toll that addiction- instigated arguments, abuse, and neglect take on families cannot be measured. It is equally reasonable to call addiction a disease of friendship and of the workplace. Addiction’s toll at work is measured in terms of bil- lions of dollars in lost productivity. Wherever an addicted person lives, works, or plays, the quality of life narrows. Here are a few figures for substance addiction: • On any given day, 8 percent of the population drinks in a manner warranting treatment, and at least 4 percent are addicted to other substances. • Close to three million women over age sixty are addicted to prescrip- tion medications (National Center on Addiction and Substance Abuse at Columbia University, 2000). • At least once a month, thirty-three million adults drink sufficient amounts of alcohol to impair judgment, leading to accidents, fights, and other harm. • Seventy-four percent of the general population says their lives have been negatively impacted by alcoholism (To, 2006). • Today, one quarter of all children live with a parent who is dependent on or abuses alcohol. GETTING TO KNOW ADDICTION ■ 3 Addictions Are Not Confined to Substance Use and Abuse The number of addicted people keeps getting higher. Virtually any behav- ior can become a full-fledged addiction, and the list of familiar addictive behaviors is growing. Gambling is the best known of the behavioral addic- tions. Consider computer games or Internet porn as just a couple of the more recent examples of recreational behaviors that can evolve into destruc- tive addictions. These behavior-based addictions only add to the substantial emotional and financial costs tabulated for substance addictions. These numbers, while enormous, significantly underrepresent the overall problem because they are based on addictions that have been diagnosed. Unrecog- nized addictions far exceed those that are identified. Most Addictions Are Disguised For each person in your life who you know has a substance addiction, you have relationships with nine others whose addiction is not recognized (National Center on Addiction and Substance Abuse at Columbia Univer- sity, 2000). Here is a real life example of the damaging effects of alcohol that went unrecognized. For years Marla had a serious problem with anger. Despite recognizing its destructive effects on her spouse and young children, she struggled to control her behavior. Sometimes she was successful; most often she was not. Her own mother had been prone to unpredictable fits of rage and this only added to Marla’s worry. She knew that her mother’s angry outbursts had damaged her self-esteem. The last person she wanted to act like was her mother. I am a psychotherapist who believes the past influences the present, and so it seemed reasonable to me that talk therapy would be just what was needed.